Biomedical subjects
Publications and source records attributed to W Theisinger.
A double-blind trial with placebo conducted on 100 patients likely to develop stress ulcers after major surgery showed that prophylactic treatment with a long-acting secretin in doses of 10 clinical units twice daily is extremely effective.
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In a prospective randomized study th efficacy and tolerance of the conventional low dose heparin regimen was compared with a new combination of dihydroergotamine (DHE) and a reduced proportion of heparin (Heparin-Dihydergot 2500) with regard to postoperative thromboembolism prophylaxis in 350 general surgical patients. The result showed that the new combination had the same thrombotic protective action as low dose heparin monotherapy, but with regard to the concomitant risk of hemorrhage it seemed a significantly superior prophylactic variant.
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The pathogenesis of stress ulcers is still far from being understood. It is reported about a synthetic secretin (Hoe 069 + depot component) given prophylactically to 100 patients postoperatively. It eliminated or ameliorated stress ulcers. The result, confirmed by gastroscopy, demonstrates the treatment with secretin plus depot component as a highly recommendable prophylaxis in the postsurgical intensive care treatment.
Bowel sounds have a close correlation to the bowel peristalsis. By analysing these sounds--using Heinkelmann's method--sounds can be expressed by objective and calculable figures. We compared the effect of ceruletide, a hormone, with the cholinesterase inhibitor neostigmine and the alpha-adrenergic blocking substance dihydroergotamine. One of the drugs was injected twice daily in patients following operations in the gastrointestinal tract starting on the 3rd and 4th p.o. day. A group of 10 patients received ceruletide in a dose of 0,3 micrograms/kg body weight and of 0,5 micrograms/kg body weight, another 10 neostigmine (0,5 mg per single dose) and 10 patients dihydroergotamine in a dose of 1 mg. Ceruletide proved to be superior to the other drugs in both groups. Its advantage is exciting an ordered propulsive peristalsis. In cases of prolonged postoperative bowel atony or paralysis ceruletide is a helpful drug. Severe side effects were not seen.
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2136 patients in general surgery, gynaecology and urology were investigated by the 125I-fibrinogen-uptake-test for detection of postoperative deep vein thrombosis (DVT). They received at random one of low-dose heparin, dihydroergotamine, the fixed combination of both drugs (Heparin-Dihydergot), low molecular weight dextran and acetylsalicylic-acid (ASS). When DVT was detected repeated lung perfusion scintigraphies were carried out for diagnosis of embolic pulmonary perfusion defects. Results demonstrate the outstanding effect of Heparin-Dihydergot, which is not only 2-3 times better than the anti-thrombotic standard low-dose heparin but also eliminates almost completely the risk of postoperative embolism. The preventive efficacy of ASS and dextran must be considered to be poor and not comparable to that obtained when using heparin, dihydroergotamine or the combination. Now Heparin-Dihydergot is the new standard with which all prophylactic procedures should be compared.
Several examples show the five pathogenetic patterns of stress-ulcer induction. Own clinical experiences with 60 cases of stress-ulcers from 1973 to 1974 are described. Our studies on the effect of Vit. A und STH on stress-ulcera are compared with those of other authors and are critically discussed. The different excretion patterns of the group I and group II pepsinogens are pointed out. Difficulties exist not only from here but also from the unknown correlation between serum and urine pepsinogens as far as the attempt is concerned, to work out a pattern to diagnose stress-ulcera before they become clinically manifest.
In 632 patients efficacy of dihydroergotamine (DHE) in preventing postoperative deep venous thrombosis (DVT) and pulmonary embolism (PE) was tested vs. low-dose heparin (LDH) by means of the 125I-fibrinogen uptake test (RFUT). The incidence rate of DVT dropped from 36% (untreated group) to 17% after LDH, to 13% after DHE, and to 9% after simultaneous prophylaxis with both drugs. In patients with lower risk operations lasting not longer than 2 hs complete prevention of DVT was achieved by combined use of LDH and DHE. PE incidence in repeated lung perfusion scans of patients with positive RFUT was reduced to 4.3-2.6% (treated groups) in comparison to an incidence of 50% in the control group. This means the decrease of PE was overproportional in all treatment groups in comparison to the decrease of DVT incidence. The combined use of LDH and DHE may be considered as the best prophylactic regimen available for lowering postoperative DVT and PE.
Slowing of venous return is, in addition to endothelial damage and hypercoagulability, one of the decisive factors in the development of thrombi. This is especially so in operated patients with loss of vessel tone caused by general anaesthesia. The radiofibrinogen test was used on a group of 106 patients to check whether the administration of dihydroergotamine, which produces vasoconstriction particularly of the venous channels, can bring about a reduction in the incidence of postoperative thrombo-embolism. There was a statistically (variance analysis) highly significant difference in the average thrombosis rate between treated (8.8%) and untreated (34.7%) patients. In patients especially at risk, the rate was more than three times as high in the untreated group (39.5% and 12.9%, respectively). In low-risk patients the rate actually dropped to zero (from 20%).
The determination of the serum level of TSH, the essential factor in goitrogenesis, was the best indicator in order to recognize imminent recurrence of goitre in strumectomized patients. The functional reserve of the hypothalamic-pituitary system proved to be important: Elevation of basic TSH level and increase of TSH after stimulation with TRH was significantly higher in patients with recurrent goitre. We, therefore, recommend this test for the postoperative surveillance of patients after strumectomy.
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